Non-sliding soft anchor

ABSTRACT

A method for coupling tissue includes aligning a guide tool on an outer surface of a first tissue; forming a bore in the first tissue aligned with the guide tool; deploying a non-slip suture construct through the (wide tool and into the bore; adjusting a saddle along a flexible member to a position adjacent to a soft anchor, wherein the saddle prevents the flexible member from slideably moving relative to the soft anchor; and threading the flexible member through a second tissue to secure the second tissue to the first tissue.

FIELD

The present disclosure relates to an apparatus and method for coupling a first tissue to a second tissue, such as coupling soft tissue to bone.

BACKGROUND

The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.

Arthroscopic procedures often include sutures and anchors to secure soft tissue to bone. Despite their widespread use, sutures and suture anchors, as well as methods for their use, can be improved. For example, tying knots in sutures may be very time consuming and difficult to perform, particularly inside the joint space. As a result, the cost of the procedure may be increased and the capacity of the surgeon may be limited. Furthermore, the strength of the repair may be limited by the strength of the knot.

Another, more specific example of an area for improvement, is in the area of rotator cuff repair. During rotator cuff repair, the suture anchor is inserted within the bone, and the sutures are threaded through the tissue and tied on top of the tissue to secure the placement of the tissue relative to the bone. When placing the knot in the suture, doctors and surgeons must be aware of the potential for tissue strangulation in the area of the knot.

The method and apparatus disclosed herein addresses these issues and numerous others.

SUMMARY

This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.

The present disclosure provides for a non-slip suture construct for coupling tissue. The non-slip suture construct includes a flexible member having a first end and a second end opposite to the first end. A soft anchor is slideably received on the flexible member, and a saddle defines an adjustable loop. The first end of the flexible member is passed through the soft anchor and saddle to define the adjustable loop. The flexible member is tensioned to compress the saddle, reduce a size of the adjustable loop, and deform the soft anchor from a first state to a second state. The saddle maintains tension on the soft anchor and retains the soft anchor in the second state and slideably fixed relative to the suture.

The present disclosure provides for a system for implanting a non-slip suture construct for coupling tissue. The system includes an insertion tool having a handle and a rod extending from the handle. The rod includes a channel and a plurality of peaks on a distal end opposite the handle. A flexible anchor of the non-slip suture construct has a first end and a second end opposite to the first end. The flexible anchor defines a passageway extending from a first opening to a second opening, and the flexible anchor is retained in the channel between the plurality of peaks. A suture includes a first end and a second end. The suture is slideably threaded through the passageway defined by the flexible anchor, and the first end and the second end of the suture retained in the handle of the insertion tool. A saddle is defined by the suture and has a passage extending from a third opening to a fourth opening. The handle is configured to retain the suture. The non-slip suture construct is configured such that the saddle is configured to maintain tension on the flexible anchor and retains the flexible anchor in a deformed state and slideably fixed relative to the suture.

The present disclosure provides for a method for coupling tissue including aligning a guide tool on an outer surface of a first tissue; forming a bore in the first tissue aligned with the guide tool; deploying a non-slip suture construct through the guide tool and into the bore; adjusting a saddle along a flexible member to a position adjacent to a soft anchor, wherein the saddle prevents the flexible member from slideably moving relative to the soft anchor; and threading the flexible member through a second tissue to secure the second tissue to the first tissue.

The present disclosure provides for a method for coupling tissue including forming a bore in a bone; deploying a soft anchor of a suture construct into the bore, wherein the suture construct includes a flexible member having a first portion and a second portion, the soft anchor positioned between the first portion and the second portion, and a saddle positioned on the first portion; tensioning the second portion to draw the flexible member through the soft anchor and the saddle to a position adjacent to the soft anchor, wherein the saddle compresses the soft anchor within the bore, deforming the soft anchor and preventing the flexible member from slideably moving relative to the soft anchor; and threading the flexible member through a soft tissue to secure the soft tissue to the bone.

The present disclosure provides for a method for coupling tissue including forming a bore in a humerus; deploying a soft anchor of a non-slip suture construct into the bore; adjusting a saddle of the non-sop suture construct along a flexible member to a position adjacent to the soft anchor and locking the flexible member from slideably moving relative to the soft anchor; threading the flexible member around or through a rotator cuff to draw the rotator cuff to the humerus; tensioning the flexible member on a top side of the rotator cuff; affixing the tensioned flexible member to a lateral row anchor to secure the rotator cuff to the humerus; and forming a web of knotless non-slip suture constructs on the top side of the rotator cuff by inserting a plurality of non-slip suture constructs along a medial row, threading a plurality of flexible members through the rotator cuff, and affixing the plurality of flexible members to at least one lateral row anchor.

Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way.

FIG. 1 is a prior art example of current rotator cuff repair techniques;

FIG. 2 is a perspective view of an example embodiment of a suture construct according to the present disclosure;

FIG. 3 is a perspective view of another example embodiment of the suture construct according to the present disclosure;

FIGS. 4A-4B are perspective views of another example embodiment of the suture construct according to the present disclosure;

FIG. 5 is a perspective view of another example embodiment of the suture construct according to the present disclosure;

FIG. 6 is a perspective view of an insertion tool for inserting one of the suture constructs of FIGS. 2-5 into a tissue according to the present disclosure;

FIG. 7 is an environmental view of an insertion guide tool positioned at a desired angle and location on a bone;

FIG. 8 is an environmental view of the insertion guide tool of FIG. 7 and a bore formation tool creating a bore in the bone;

FIGS. 9-10 are environmental views of the insertion tool of FIG. 6 and the insertion guide tool of FIG. 7 deploying one of the suture constructs of FIGS. 2-5 in the bore in the bone;

FIG. 11 is an environmental view of the insertion tool of FIG. 6 releasing the suture constructs of FIGS. 2-5;

FIGS. 12-13 are environmental views of one of the suture constructs of FIGS. 2-5 in the bore in the bone;

FIG. 14 is an environmental view of a plurality of the suture constructs of FIGS. 2-5 in a rotator cuff;

FIG. 15 is an environmental view of suture ends of a plurality of the suture constructs of FIGS. 2-5 threaded through soft tissue;

FIGS. 16A-16B are perspective views of the suture ends of FIG. 15 threaded onto a secondary anchor insertion tool;

FIG. 17 is an environmental view of the secondary anchor insertion tool setting a secondary anchor in the rotator cuff of FIG. 14; and

FIG. 18 is an environmental view of the plurality of the suture constructs set within the rotator cuff and forming a webbed portion over the soft tissue.

Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features.

Traditional methods of securing two portions of tissue, for example soft tissue (or muscle) to bone in rotator cuff repair as shown in prior art FIG. 1, involve the use of anchors threaded on suture strands 14 and deployed within a humerus bone 18. Initially, a bore 22 is formed in the humerus 18. The anchor is deployed in the bore 22 in the bone 18 to secure the anchor. While the anchor is secured within the bore 22, the suture strands 14 may still slide relative to the anchor. Ends 26 of the suture strands 14 are threaded through a portion of a soft tissue 30 and tied into a knot 32 on a top side of the tissue 30 opposite a side of the tissue 30 adjacent to the bone 18 to secure the placement of the tissue 30 relative to the bone 18 and to keep the suture ends 26 from sliding relative to the anchor. The suture ends 26 are then tied off to secondary anchors 34 fixed within the humerus 18, forming a webbed portion 38 over the tissue 30 and securing the tissue 30 to the bone 18.

In other words, the suture ends 26 extend from the anchor in the bore 22, through the soft tissue 30, and are tied in the knot 32 on top of the soft tissue 30 directly above the bore 22 in the bone 18, as illustrated in FIG. 1. The suture ends 26 are knotted on the top side of the soft tissue 30 to fix the suture 14 relative to the anchor to prevent the suture ends 26 from sliding relative to the anchor in the humerus 18. Without forming the knot 32, the suture ends 26 may move relative to the anchor in the humerus 18. The suture ends 26 extend from the knot 32 to the secondary anchors 34 fixed within the bone 18 and are tied off to the secondary anchors 34. This procedure is described in “JuggerKnot Soft Anchor: Arthroscopic and Mini-Open Rotator Cuff Repair Using JuggerKnot Soft Anchor—2.9 mm with ALLthread Knotless Anchor Surgical Technique,” a publication produced by Biomet Sports Medicine and incorporated herein in its entirety. This disclosed method, while overcoming many hurdles in price, ease of use, and others, still contains room for improvement. For example, the ability to quickly install the soft anchors and thread the suture ends through the tissue will always be an area for improvement. The present disclosure strives to address these areas and others to create a more efficient suture construct for joining two portions of tissue, specifically for joining soft tissue to bone.

With general reference to FIGS. 2-5 and specific reference to FIG. 2, a non-sliding suture construct 100 incorporating a soft anchor 104 and a saddle, or passage portion, 108 is illustrated. The non-sliding suture construct 100 generally includes the soft anchor 104 connected to a flexible member, or suture, 112 having a first portion 116 adjacent to a first end 120 and a second portion 124 adjacent to a second end 128 which is opposite the first end 120. The saddle, or passage portion, 108 may be positioned between the first portion 116 and the second portion 124. The suture 112, saddle 108, and soft anchor 104 can be made of any flexible material or member, and need not be made of a suture. The suture 112, saddle 108, and soft anchor 104 can be made of the same or different materials. When the suture 112, saddle 108, and soft anchor 104 are made of sutures, any suitable suture can be used. For example, a braided hollow-core suture can be used. The braided suture can include a first end and a second end with an outer wall that defines a passage therethrough. Any suitable braided suture can be used such as any of the braided sutures disclosed in U.S. patent application Ser. No. 12/915,962 titled Method and Apparatus for Securing Soft Tissue to Bone, which was filed on Oct. 29, 2010, published as Publication No. 2011/0098727 on Apr. 28, 2011, and is assigned to Biomet Sports Medicine, LLC. The entire disclosure of the Ser. No. 12/915,962 Application is incorporated herein by reference. To help distinguish between the suture 112, saddle 108, and soft anchor 104, or to distinguish between the first portion 116 and the second portion 124, which can be particularly helpful for a surgeon during surgery, the suture 112, saddle 108, soft anchor 104, first portion 116, and second portion 124 can be provided with an identifying characteristic such as different colors or designs, for example and as further described below. The suture 112 may be any suitable length, such as, for example, about thirty-eight (38) inches.

As illustrated in FIGS. 2-5, the saddle 108 may be an integral portion of the suture 112 and may be proximate to one of the first end 120 and second end 128. While the saddle 108 is illustrated as being proximate to the second end 128, it may alternatively be proximate to the first end 120 or at any suitable position therebetween. In an example embodiment, the suture 112 defines an elongated passage 132 extending along at least a portion of the suture 112. If the suture 112 is a braided hollow-core suture, the passage 132 can extend from the first end 120 to the second end 128 of the suture 112. The saddle, or passage portion, 108 can be formed by a portion 108 of the passage 132 that exits through an outer wall of the suture 112 at a first opening 136 and a second opening 140 at opposite ends of the passage portion 108. The second opening 140 is closer to the second end 128 of the suture 112 than the first opening 136. The second opening 140 is spaced apart from the second end 128. The first end 120 and first portion 116 may be passed through the first opening 136 along the passage 132, extend through the passage 132, and out the second opening 140 to define an adjustable loop 142 in the suture construct 100.

The soft anchor 104 may be a flexible anchor slideably positioned at any suitable position between the first end 120 and the second end 128 of the suture 112, such as about halfway between the first end 120 and the second end 128. The soft anchor 104 is preferably positioned between the first end 120 and the saddle 108 when the saddle 108 is proximate to the second end 128 and between the second end 128 and the saddle 108 when the saddle 108 is proximate to the first end 120. The soft anchor 104 may also be positioned on the adjustable loop 142. The soft anchor 104 can be an elongate member having a sleeve or tubular configuration with a first anchor end 144 and a second anchor end 148 opposite the first anchor end 144. An internal passage 152 is defined by a wall of the soft anchor 104 and extends between the first anchor end 144 and the second anchor end 148. In some embodiments, the internal Massage 152 extends from the first anchor end 144 to the second anchor end 148. In other embodiments, the internal passage 152 extends from a first anchor opening 156 at a location proximate to, but spaced apart from, the first anchor end 144 to a second anchor opening 160 at a location proximate to, but spaced apart from, the second anchor end 148. The soft anchor 104 can be made of resorbable or non-resorbable materials, including braided suture, sponges and sponge-like materials in solid form, perforated materials, woven/braided from biocompatible materials or fibers, such as, for example, polymer, polyester, polyethylene, cotton, silk, or other natural or synthetic materials.

The soft anchor 104 can have properties that allow the soft anchor 104 to change shape. In this regard, the soft anchor 104 can be, for example, compliant, flexible, foldable, squashable, squeezable, deformable, limp, flaccid, elastic, low-modulus, soft, spongy, or perforated, or have any other characteristic property that allows it to change shape. In some aspects, the soft anchor 104 can be coated with biological or biocompatible coatings and also can be soaked in platelets and other biologics, which can be easily absorbed by the soft anchor 104. In one embodiment, the soft anchor 104 can be formed from a strand of No. 5 braided polyester suture. In other words, multiple fibers can be braided together to form a hollow-core braided suture having a longitudinal passage.

When the saddle 108 is proximate to the second end 128, the first end 120 of the suture 112 can be passed through the second anchor opening 160, guided into and along the internal passage 152, and passed out of the internal passage 152 through the first anchor opening 156 defining the adjustable loop 142. When the saddle 108 is proximate to the first end 120, the second end 128 of the suture 112 can be passed through the first anchor opening 156, guided into and along the internal passage 152 and through the second anchor opening 160 defining the adjustable loop 142. The first and second anchor openings 156, 160 can be apertures or voids in the woven fabric of the soft anchor 104, such that the first and the second anchor openings 156, 160 do not disrupt or break the weave of the soft anchor 104 between the first and the second anchor ends 144, 148. The corresponding first and second anchor openings 156, 160 can define leg or tail portions 164 that can provide additional resistance for securing the soft anchor 104 relative to the bone. The soft anchor 104 described in the present disclosure may be the same as or similar to the anchor described in U.S. Patent Publication No. 2013/0144338, published on Jun. 6, 2013 and assigned to Biomet Sports Medicine, LLC, which is incorporated herein by reference.

When assembled, the suture construct 100 is a non-sliding suture construct. The soft anchor 104 and saddle 108 are positioned on the suture 112 such that the anchor 104 and saddle 108 are slideably movable along the suture 112. The first end 120 is pulled to tighten the suture 112 and reduce the size of the adjustable loop 142. As the size of the adjustable loop 142 decreases, second anchor end 148 abuts first opening 136 in saddle 108 and compresses soft anchor 104 such that the soft anchor 104 deforms. The first portion 116 that is fed through the second portion 124 to form the saddle 108 exerts a frictional force on the passage 132 and openings 136, 140 of the saddle 108 to resist movement of the first portion 116 within the saddle 108 and thereby lock the soft anchor 104 in the deformed position and prevent the suture 112 from slideably moving within the soft anchor 104.

Now referring to FIGS. 3, 4A, and 4B, alternative embodiments 200 and 300 of the non-sliding suture construct 100 are illustrated. The alternative embodiments 200, 300 include the same soft anchor 104 and saddle 108 as described in relation to suture construct 100. Similar to suture 112 of suture construct 100, non-sliding suture construct 200 (FIG. 3) includes a suture 204 having a first portion 208 adjacent to a first end 212 and a second portion 216 adjacent to a second end 220 which is opposite the first end 212, and non-sliding suture construct 300 (FIGS. 4A-4B) includes a suture 304 having a first portion 308 adjacent to a first end 312 and a second portion 316 adjacent to a second end 320 which is opposite the first end 312. To help distinguish between the first portion 208, 308 and the second portion 216, 316, which can be particularly helpful for a surgeon during surgery, the first portion 208, 308 and second portion 216, 316 can be provided with an identifying characteristic such as different colors or designs, for example. The identifying characteristic may be the same as, or similar to, the identifying characteristics described in U.S. patent application Ser. No. 13/791,014, assigned to Biomet Sports Medicine, LLC, which is incorporated by reference herein.

Referring specifically to FIG. 3, the first portion 208 and second portion 216 may be provided with different colors, designs, and indicia. As illustrated in the figure, the first portion 208 may be a plain white, or other solid color, suture, while the second portion 216 may include an identifier characteristic such as a color coating 224, or one or more colored strands, on a portion of the suture 204. The suture 204 may include an outer wall 228 formed from a plurality of strands (not illustrated) braided together. Each strand may further include a plurality of fibers (not illustrated) braided together to form the strand. The plurality of fibers may be an all-white polyethylene material that is braided to form the plurality of strands. In other embodiments, the plurality of fibers may also include one or more colored strands woven into the all-white polyethylene material.

In an example embodiment, the second portion 216 may be coated with a dye or other material that is known to adhere to the polyethylene material. The dye or other material may be of a contrasting color to the all-white polyethylene and therefore may provide the color coating 224 on a portion of the suture 204. In some embodiments, the color coating 224 may be applied to the entire second portion 216 (not illustrated). In other embodiments, the color coating 224 may be applied in specific locations of the second portion 216 (for example, similar to the candy cane stripe illustrated in FIG. 3), distinguishing the second portion 216 from the first portion 208. In other embodiments, the second portion 216 may include one or more colored strands to either form a striped strand or a strand of a different color from the first portion 208. The differences between the first portion 208 and the second portion 216 become more apparent when the suture 204 is threaded through the soft anchor 104. The differences help to identify the direction of travel and corresponding ends each of the first and second portions 208, 216. The color 224 on only a portion of the suture 204 as described in relation to FIG. 3 may be further described in U.S. patent application Ser. No. 13/791,014, assigned to Biomet Sports Medicine, LLC, which is incorporated by reference herein.

Referring specifically to FIGS. 4A and 4B, the first portion 308 and second portion 316 may be provided with different designs. The first portion 308 may be a 16-strand hollow-core suture and may include an outer wall 324 formed from a plurality of strands braided together. Each strand may further include a plurality of fibers braided together to form the strand. The second portion 316 may be a 16-strand flat braided ribbon formed from the plurality of strands braided together. Each strand may further include the plurality of fibers braided together to form the strand. The round or cylindrical shape of the first portion 308 is distinguished from the flat shape of the second portion 316 both by touch and sight to assist the surgeon in distinguishing the first portion 308 from the second portion 316. The embodiment described in relation to FIGS. 4A and 4B may be further described in U.S. patent application Ser. No. 13/791,014, assigned to Biomet Sports Medicine, LLC, which is incorporated by reference herein.

When assembling the suture construct 300, the flat, second portion 316 is threaded through the cylindrical, first portion 308 to form the saddle 108. This embodiment may provide superior gripping capability due to a higher frictional force between the flat, second portion 316 and the wall of the passage 132 and the openings 136, 140 of the saddle 108.

The suture 304 may include a plurality of first portions 308 and second portions 316 as best illustrated in FIG. 4A. When multiple first portions 308 and second portions 316 are included, the first portions 308 will not always be proximate to the first end 312 and the second portions 316 will not always be proximate to the second end 320. If the suture 304 includes the plurality of first portions 308 and second portions 316, the first end 312 will be one of the first portion 308 and second portion 316 and the second end 320 will be the other of the first portion 308 and the second portion 316 to distinguish the first end 316 from the second end 320. Further, if the suture 304 includes the plurality of first portions 308 and second portions 316, the plurality of first portions 308 and second portions 316 will be arranged such that one of the plurality of second portions 316 is threaded through one of the plurality of first portions 308 to form the saddle 108.

Now referring to FIG. 5, another embodiment of a non-sliding suture construct 400 is illustrated. The non-sliding suture construct 400 operates similarly to the non-sliding suture constructs 100, 200, 300 where the first portion 116 that is fed through the second portion 124 to form the saddle 108 exerts a frictional force on the passage 132 and openings 136, 140 of the saddle 108 to resist movement of the first portion 116 within the saddle 108 and thereby lock the soft anchor 104 in the deformed position and prevent the suture 112 from slideably moving within the soft anchor 104.

Suture construct 400 implements two sutures 112, 112′, two saddles 108,108′, and a single soft anchor 104. FIG. 5 is formed by taking a suture construct similar to the suture construct 100 in FIG. 2 and threading a first portion 116′ of a second suture 112′ through the second anchor opening 160 in the soft anchor 104, through the internal passage 152, and out the first anchor opening 156 in the soft anchor 104. The first portion 116′ is then threaded through a second portion 124′ of the second suture 112′ to form the second saddle 108′, similar to the saddle 108 in suture construct 100. Usage of the suture construct 400 provides doctors and/or surgeons with the availability of additional suture ends. It is understood that while only two sutures 112, 112′ with two saddles 108, 108′ are threaded through the soft anchor 104, any number of sutures having saddles may be utilized.

With additional reference to FIGS. 6-18, a method for implanting one of the non-sliding suture constructs 100, 200, 300, 400 in a bone 500 to secure a tissue 504 to the bone 500 will now be described. As illustrated, the bone 500 may be a humerus and the soft tissue 504 may be a rotator cuff. The non-sliding suture construct 100, 200, 300, 400 can be used to secure a torn rotator cuff or labrum in place. The bone 500 includes a hard, outer cortical bone layer 508 and a softer, inner cancellous bone layer 512.

For brevity and clarity, it is noted that the method of implanting one of the non-sliding suture constructs 100, 200, 300, 400 in the bone 500 to secure the tissue 504 to the bone 500 is described using non-sliding suture construct 100. However, the method of implanting one of the non-sliding suture constructs 100, 200, 300, 400 in the bone 500 to secure the tissue 504 to the bone 500 may be performed using any of the non-sliding suture constructs 100, 200, 300, 400 described herein, or using any similar suture constructs known.

Now referring to FIG. 6, the suture construct 100 is loaded on an insertion tool 516. The insertion tool 516 generally includes a body 520 and a handle 524. The body 520 is an elongated rod that may be cylindrical in shape. The body 520 is attached to the handle 524 at a proximal end 528 and includes a tip 532 having a plurality of peaks 536 separated by a channel 540 at a distal end 544.

The handle 524 further includes a first channel 548 extending along a longitudinal axis of the handle 524 and a second channel 552 extending radially around the handle 524. The handle 524 may further include a tubular post 556 and cap 560 for securing the suture 112 to the handle 524.

The insertion tool 516 may be the same or similar to any of the insertion tools disclosed in “JuggerKnot Soft Anchor: Arthroscopic and Mini-Open Rotator Cuff Repair Using JuggerKnot Soft Anchor—2.9 mm with ALLthread Knotless Anchor Surgical Technique,” a publication produced by Biomet Sports Medicine and incorporated herein in its entirety. The insertion tool 516 may also be same or similar to any of the insertion tools disclosed in U.S. Patent Publication No. 2013/0144338, published on Jun. 6, 2013 and assigned to Biomet Sports Medicine, LLC, which is incorporated herein by reference.

The soft anchor 104 is positioned on the tip 532 of the insertion tool 516 along the channel 540 and between the peaks 536. The suture 112 extending from the soft anchor 104 is positioned parallel with and proximate to the body 520 and is received within the first channel 548 in the handle 524. In an example embodiment, the suture 112 is secured to the handle 524 by wrapping the suture 112 around the first channel 548 and/or the second channel 552 of the handle. In another embodiment, the suture 112 is secured to the handle 524 by threading the suture 112 through a bore in the post 556. The suture is fixed within the post 556 by threading or pressing the cap 560 on the end of the post 556 and compressing the suture 112 between the post 556 and cap 560. Each of these methods of loading the suture construct 100 on the insertion tool 516 is further disclosed and described in “JuggerKnot Soft Anchor: Arthroscopic and Mini-Open Rotator Cuff Repair Using JuggerKnot Soft Anchor—2.9 mm with ALLthread Knotless Anchor Surgical Technique,” a publication produced by Biomet Sports Medicine and U.S. Patent Publication No. 2013/0144338, published on Jun. 6, 2013 and assigned to Biomet Sports Medicine, LLC. The disclosures of each are incorporated herein in their entireties.

As illustrated in FIGS. 7 and 8, a bone hole 564 is formed in the bone 500 using any suitable device, such as a surgical drill. The bone hole 564 is formed along a medial row of the bone 500 and proximate to the tissue 504 to be secured to the bone 500. To form the bone hole 564, an insertion guide 568 is positioned at the desired angle and location on the bone 500 as illustrated in FIG. 7. The insertion guide 568 is an elongated tubular rod having a bore 572 centered within the insertion guide 568 and extending along a longitudinal axis of the insertion guide 568 from a first, distal end 576 to a second, proximal end 580 of the insertion guide 568. The insertion guide 568 further extends through a handle 584 positioned at the proximal end 580 of the insertion guide 568. The insertion guide 568 may further include a window 588 proximate to the distal end 576 of the insertion guide 568 to provide viewing capability into the bore 572. The insertion guide 568 may be further described in “JuggerKnot Soft Anchor: Arthroscopic and Mini-Open Rotator Cuff Repair Using JuggerKnot Soft Anchor—2.9 mm with ALLthread Knotless Anchor Surgical Technique,” a publication produced by Biomet Sports Medicine and incorporated herein in its entirety.

Now referring specifically to FIG. 8, a bore formation tool 592, such as a surgical drill, is inserted into the bore 572 in the insertion guide 568. In an example embodiment, the bore formation tool 592 may include a drill handle 596, a driving rod 600, and a reamer 604. The reamer 604 is positioned on a distal end 608 of the bore formation tool 592, and the drill handle 596 which drives the driving rod 600, and in effect the reamer 604, is positioned on a proximal end 612 of the bore formation tool 592. In another embodiment, the bore formation tool 592 may include a punch (not illustrated) on the distal end 608 of the bore formation tool 592 and a handle (not illustrated) configured for malleting on the proximal end 612 of the bore formation tool 592. The bore formation tool 592 may be further described in “JuggerKnot Soft Anchor: Arthroscopic and Mini-Open Rotator Cuff Repair Using JuggerKnot Soft Anchor—2.9 mm with ALLthread Knotless Anchor Surgical Technique,” a publication produced by Biomet Sports Medicine and incorporated herein in its entirety.

The driving rod 600 and reamer 604 are inserted within the bore 572 of the insertion guide 568 and are engaged with the bone 500 to form the bone hole 564. The bore formation tool 592 is inserted into the bore 572 until the drill handle 596 contacts the handle 584 of the insertion guide 568 indicating an appropriate depth of the bone hole 564 in the bone 500. At an appropriate depth, the bone hole 564 may traverse through the cortical bone layer 508 and into the cancellous bone layer 512. The window 588 in the insertion guide 568 may be additionally helpful in monitoring the depth of the bone hole 564, such as for viewing depth indicia indicated on the driving rod 600. The bore formation tool 592 is then removed from the insertion guide 568.

Now referring to FIGS. 9 and 10, the soft anchor 104 is deployed and secured within the bone 500. The insertion tool 516, with the suture construct 100 preloaded, is inserted into the bore 572 in the insertion guide 568. As illustrated in FIG. 9, the soft anchor 104 is inserted into the bone hole 564 and positioned such that the first anchor end 144 and the second anchor end 148 abut an undersurface 616 of the cortical bone layer 508 at opposite sides of the bone hole 564, which restricts the suture tail 164 from being pulled out from within the bone 500. The soft anchor 104 can be inserted using any suitable inserter, such as those described herein. The Ser. No. 12/915,962 Application, which is incorporated by reference, provides additional disclosure for forming a bone hole and implanting a flexible anchor. The additional disclosure of the Ser. No. 12/915,962 Application also applies to the forming of bone hole 564 and insertion of anchor 104 within the bone hole 564.

As illustrated in FIG. 10, the insertion tool 516 is partially removed from the bone hole 564 to pull back on the suture 112 and soft anchor 104. This action will deform the soft anchor 104 from a first position (FIG. 9) to a second position (FIG. 10). When in the first position, the soft anchor 104 may be a generally horseshoe-shaped or u-shaped configuration, and the suture 112 may be slideably movable relative to the soft anchor 104. When in the second position, the soft anchor 104 may be a generally bunched configuration, and the suture may be fixed relative to the soft anchor 104.

Now referring to FIG. 11 the first and second suture ends 120, 128 are released from the insertion tool 516. In an example embodiment, the first and second suture ends 120, 128 are released by removing the cap 560 from the post 556 and releasing the compression of the suture 112 between the cap 560 and the post 556. In another embodiment, the first and second suture ends 120, 128 are released by unwrapping the suture 112 from the first and second channels 548, 552 (FIG. 6). Release of the suture ends 120, 128 free the suture construct 100 from the insertion tool 516 and allow the insertion tool 516 to be removed from the insertion guide 568.

Now referring to FIG. 12, the insertion tool 516 is removed from the insertion guide 568, and the insertion guide 568 is removed from the outer surface of the bone 500. The first and second suture ends 120, 128 are threaded back through the insertion guide 568 to free the insertion guide 568 from the suture construct 100 and the surface h bone 500. As the insertion tool 516 and the insertion guide 568 are removed from the bone 500, tension is kept on the first and second ends 120, 128 of the suture 112 such that the soft anchor 104 remains deformed in the second position or configuration within the bone hole 564.

Now referring to FIG. 13, the saddle 108 is slideably moved along the suture 112, or tightened, to a position within the bone hole 564 proximate to the soft anchor 104. The first end 120 of the saddle 108 is pulled to tighten the suture 112 and reduce the size of the adjustable loop 142. As the size of the adjustable loop 142 decreases, the saddle 108 is drawn into the bone hole 564, the second anchor end 148 abuts the first opening 136 in the saddle 108, and the saddle 108 compresses the soft anchor 104 such that the soft anchor 104 further deforms.

The saddle 108 is inserted within the bone hole 564 until the second opening 140 of the saddle 108 is at least flush with the surface of the bone 500. As the saddle 108 is tightened along the suture 112, the soft anchor 104 continues to deform, or bunch, within the bone hole 564. Once the saddle 108 is proximate to the soft anchor 104 and the second opening 140 of the saddle 108 is at least flush with the surface of the bone 500, the saddle 108 fixes the sutures 112 by applying static friction between the exterior surface of the suture 112 and the interior surface of the passage 132. The first portion 116 that is fed through the second portion 124 to form the saddle 108 exerts a frictional force on the passage 132 and openings 136, 140 of the saddle 108 to resist movement of the first portion 116 within the saddle 108 and thereby lock the soft anchor 104 in the deformed position and prevent the suture 112 from slideably moving within the soft anchor 104. The static friction results in an automatic lock that maintains tension on the suture 112 in the soft anchor 104, retaining the soft anchor 104 in the deformed, or bunched, position. The saddle 108 locks movement of the suture 112 relative to the soft anchor 104 such that the suture 112 cannot slip through the anchor 104.

Now referring to FIGS. 14 and 15, a plurality of suture constructs 100 may be inserted medially, near an articular margin 620 of the humerus 500 (FIG. 14). In an example embodiment, the first and second ends 120, 128 of the plurality of suture constructs 100 are threaded through the tissue, or rotator cuff, 504 (FIG. 15). The tissue 504 is threaded along the suture 112 until proximal to the bone 500 at a position on the suture 112 that is near the saddle 108 in the bone hole 564 of the bone 500. This configuration is additionally illustrated in FIG. 17. The method of threading the first and second ends 120, 128 may be additionally described in “JuggerKnot Soft Anchor: Arthroscopic and Mini-Open Rotator Cuff Repair Using JuggerKnot Soft Anchor—2.9 mm with ALLthread Knotless Anchor Surgical Technique,” a publication produced by Biomet Sports Medicine and incorporated herein in its entirety. In other embodiments, the first and second ends 120, 128 of the plurality of suture constructs 100 may be passed around the tissue, or muscle, 504.

Since the saddle 108 was tightened against the soft anchor 104 preventing the suture 112 within the soft anchor 104 from sliding relative to the soft anchor 104, it is unnecessary to fix the sutures on a top side 624 of the tissue 504 as previously practiced. In other words, the knotless sutures are threaded from the soft anchor 104, through the tissue 504, and are affixed to secondary anchors in the bone 500, as further described below. No knots are tied in the sutures 112, unless a knot is used to affix the suture 112 to the secondary anchor 628, and in that instance, a knot is only placed in the suture 112 to affix the suture to the secondary anchor 628—the suture 112 extends from the soft anchor 104, through the tissue 504, and to the secondary anchor 628 without forming any knots between the soft anchor 104 and the secondary anchor 628. A plurality of knotless sutures are tensioned on the top side 624 of the tissue 504 to create a web of suture over the tissue 504. Restraining the suture 112 within the soft anchor 104 before threading the suture 112 through the tissue 504 prevents any potential tissue strangulation from knotting or fixing the suture on the top side 624 of the tissue 504.

Now referring to FIGS. 16A-16B, the sutures 112 are threaded through (or passed around) the tissue 504 are threaded onto a secondary anchor 628 using a passing wire tool 632. The sutures 112 are threaded through a loop 636 in the passing wire tool 632 as shown in FIG. 16A, and pulled through a tunnel 640 in the secondary anchor 628. The passing wire tool 632 continues to direct the sutures 112 through a passage 644 in a secondary anchor inserter tool 648 to load the secondary anchor 628 and suture 112 on the secondary anchor inserter tool 648. Further description of the secondary anchor insertion tool 648 and the method of loading the secondary anchor 628 and the suture 112 in the tool can be found in “JuggerKnot Soft Anchor: Arthroscopic and Mini-Open Rotator Cuff Repair Using JuggerKnot Soft Anchor—2.9 mm with ALLthread Knotless Anchor Surgical Technique,” a publication produced by Biomet Sports Medicine and incorporated herein in its entirety.

Now referring to FIG. 17, one or a plurality of secondary anchor bores, or lateral portals, 652 is formed in a lateral row 656 of the humerus 500. The secondary anchor bores 652 may be formed by punching, malleting, drilling, any method discussed in the present disclosure, or any other known method. The secondary anchor insertion tool 648 containing the secondary anchor 628 and suture 112 is inserted in the lateral portal 652 and positioned such that the secondary anchor 628 is at the same angle of insertion as the soft anchor 104 and saddle 108. The secondary anchor insertion tool 648 containing the secondary anchor 628 may be malleted to assist in inserting the secondary anchor 628 within the lateral portal 652. While maintaining tension on the suture, the secondary anchor 628 is pressed the remainder of the distance into the lateral portal 652. The secondary anchor 628 may also be firmly screwed into the lateral portal 652 until the secondary anchor 628 is flush with the bone 500. Once the secondary anchor 628 is flush with the bone 500, the excess suture may be removed by cutting. The method of inserting the secondary anchors 628 into the lateral portals 652 may be further described in “JuggerKnot Soft Anchor: Arthroscopic and Mini-Open Rotator Cuff Repair Using JuggerKnot Soft Anchor—2.9 mm with ALLthread Knotless Anchor Surgical Technique,” a publication produced by Biomet Sports Medicine and incorporated herein in its entirety.

Now referring to FIG. 18, a plurality of secondary anchors 628 may be inserted into a plurality of lateral portals 652 formed in the lateral row 656. The use of a plurality of suture constructs 100, 200, 300 (or the use of suture constructs 400) with a plurality of secondary anchors 628 forms a web 660 of sutures retaining the tissue 504 against the bone 500.

As previously described, the suture construct 100, 200, 300, 400 allows a first tissue to be coupled to a second tissue without the need to tie knots, which makes surgery, particularly arthroscopic procedures, easier and faster. In some instances, by eliminating the need to tie knots the suture construct 100, 200, 300, 400 may make the connection between first and second tissues more reliable. The suture 112 is passed through or around tissue, particularly during arthroscopic procedures. The suture 112 may be passed through or around the tissue before or after the anchor 104 has been implanted, which can further expedite and make arthroscopic procedures less complicated.

Some or all of the suture construct 100, 200, 300, 400, the insertion guide 568, the bore formation tool 592, the insertion tool 516, the passing wire tool 632, the secondary anchor inserter tool 648, and the secondary anchor 628 may be included in a kit or a system for implanting a non-slip suture construct for coupling tissue. The lengths of the various tools 516, 592 may be designed with respect to the insertion guide 568 as a method of controlling the depth of the tool within the tissue. Alternatively, or in addition, the various tools 516, 592 and/or insertion guide 568 may include depth control indicia (not illustrated) for monitoring the depth of the instrument within the tissue.

The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and can be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure. 

1-7. (canceled)
 8. A suture anchor system, comprising: a first anchor that is positionable in a bone hole; and a single braided suture with a first free end and a second free end, wherein, in a direction along the single braided suture from the first free end to the second free end, the single braided suture includes a first longitudinal section which is followed by a second longitudinal section which is followed by a third longitudinal section, the first longitudinal section and the third longitudinal section each comprising a section of the single braided suture having a hollow core, the second longitudinal section comprising a flat braided ribbon section of the single braided suture, wherein, within the suture anchor system, the single braided suture is formed into an adjustable suture construct, the adjustable suture construct including the first free end of the single braided suture extending: (i) into the single braided suture through a first opening in an outer wall of the third longitudinal section of the single braided suture; (ii) longitudinally within the single braided suture along the hollow core of the third longitudinal section of the single braided suture; and (iii) out of the single braided suture through a second opening in the outer wall of the third longitudinal section of the single braided suture to position the first free end of the single braided suture outside the single braided suture and form an adjustable loop portion of the adjustable suture construct, the first free end of the single braided suture pullable to adjust a size of the adjustable loop portion, wherein the first anchor is received on the adjustable loop portion of the adjustable suture construct.
 9. A method of forming an adjustable suture construct, comprising: obtaining a single braided suture with a first free end and a second free end, wherein, in a direction along the single braided suture from the first free end to the second free end, the single braided suture includes a first longitudinal section which is followed by a second longitudinal section which is followed by a third longitudinal section, the first longitudinal section and the third longitudinal section each comprising a section of the single braided suture having a hollow core, the second longitudinal section comprising a flat braided ribbon section of the single braided suture; sliding a first anchor that is positionable in a bone hole onto the single braided suture; and forming an adjustable suture construct with the single braided suture after sliding the first anchor onto the single braided suture, wherein said forming includes passing the first free end of the single braided suture: (i) into the single braided suture through a first opening in an outer wall of the third longitudinal section of the single braided suture; (ii) longitudinally through the single braided suture along the hollow core of the third longitudinal section of the single braided suture; and (iii) out of the single braided suture through a second opening in the outer wall of the third longitudinal section of the single braided suture to position the first free end of the single braided suture outside the single braided suture and form an adjustable loop portion of the adjustable suture construct, the first free end of the single braided suture pullable to adjust a size of the adjustable loop portion, wherein said passing leaves the first anchor on the single braided suture along the adjustable loop portion of the adjustable suture construct.
 10. The method of claim 9, wherein the first anchor is a soft anchor deformable from a first condition to a second condition in the bone hole.
 11. The method of claim 10, wherein the soft anchor comprises a tube.
 12. The method of claim 11, wherein said sliding positions the tube on the single braided suture such that the single braided suture extends longitudinally through at least part of an internal longitudinal passage in the tube.
 13. The method of claim 9, wherein said passing leaves at least part of the flat braided ribbon section of the second longitudinal section of the single braided suture extending through the hollow core of the third longitudinal section of the single braided suture and contacting an inner wall of the hollow core of the third longitudinal section of the single braided suture.
 14. The method of claim 9, wherein said passing leaves the flat braided ribbon section of the second longitudinal section of the single braided suture contacting suture material around at least one of the first opening and the second opening in the outer wall of the third longitudinal section of the single braided suture.
 15. The method of claim 9, wherein said passing leaves at least part of the first longitudinal section of the single braided suture outside the single braided suture.
 16. The method of claim 9 further comprising coupling a second anchor to the first anchor with the single braided suture.
 17. The method of claim 16, wherein the second anchor is coupled to the first anchor with a section of the single braided suture that is free of knots.
 18. The method of claim 9 further comprising mounting the anchor on a distal end of an inserter with at least part of the adjustable suture construct extending back along the inserter in a proximal direction.
 19. A method, comprising: obtaining a single braided suture with a first free end and a second free end, wherein, in a direction along the single braided suture from the first free end to the second free end, the single braided suture includes a first longitudinal section which is followed by a second longitudinal section which is followed by a third longitudinal section, the first longitudinal section and the third longitudinal section each comprising a section of the single braided suture having a hollow core, the second longitudinal section comprising a fiat braided ribbon section of the single braided suture; forming an adjustable suture construct with the single braided suture, wherein said forming includes passing the first free end of the single braided suture: (i) into the single braided suture through a first opening in an outer wall of the third longitudinal section of the single braided suture; (ii) longitudinally within the single braided suture along the hollow core of the third longitudinal section of the single braided suture; and (iii) out of the single braided suture through a second opening in the outer wall of the third longitudinal section of the single braided suture to position the first free end of the single braided suture outside the single braided suture and form an adjustable loop portion of the adjustable suture construct, the first free end of the single braided suture pullable to adjust a size of the adjustable loop portion, wherein said passing leaves at least part of the flat braided ribbon section of the second longitudinal section of the single braided suture extending through the hollow core of the third longitudinal section of the single braided suture and contacting an inner wall of the hollow core of the third longitudinal section of the single braided suture.
 20. The method of claim 19 further comprising sliding a first anchor onto the single braided suture.
 21. The method of claim 20, wherein the first anchor is a soft anchor deformable from a first condition to a second condition in the bone hole.
 22. The method of claim 21, wherein the soft anchor comprises a tube, and wherein said sliding positions the tube on the single braided suture such that the single braided suture extends longitudinally through at least part of an internal longitudinal passage in the tube.
 23. The method of claim 20, wherein the adjustable suture construct is formed after sliding the first anchor onto the single braided suture.
 24. The method of claim 23, wherein said passing leaves the first anchor on the single braided suture along the adjustable loop portion of the adjustable suture construct.
 25. The method of claim 19, wherein said passing leaves the flat braided ribbon section of the second longitudinal section of the single braided suture contacting suture material around at least one of the first opening and the second opening in the outer wall of the third longitudinal section of the single braided suture.
 26. The method of claim 25, wherein said passing leaves the flat braided ribbon section of the second longitudinal section of the single braided suture contacting an inner wall of the hollow core of the third longitudinal section of the single braided suture and suture material around both the first opening and the second opening in the outer wall of the third longitudinal section of the single braided suture.
 27. The method of claim 19, wherein said passing leaves at least part of the first longitudinal section of the single braided suture outside the single braided suture.
 28. The method of claim 19 further comprising coupling a second anchor to the first anchor with the single braided suture. 